Prostate Cancer Patients: Sexual Problems More Common after Radical Prostatectomy than Observation

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14 August, 2017

Men who undergo surgery for prostate cancer are more likely to develop long-term sexual issues than those who are observed, according to new research published last month in the New England Journal of Medicine.

The study also found that men who have surgery are more likely to experience urinary incontinence, but have a “significant lower risk of disease progression,” the authors noted.

The study began in November 1994. At that time, 731 men with localized prostate cancer were randomly assigned to one of two groups. One group was treated with radical prostatectomy, while the other group was observed, receiving treatment when problems became bothersome. The men’s average age was 67 years, and they were followed for up to 19.5 years (the median was 12.7 years).

Over the total follow-up period of 19.5 years, 61.3% of the men in the surgery group and 66.8% of the men in the observation group died. The researchers concluded that surgery did not offer significant benefits in mortality over observation for men with early-stage prostate cancer. However, men with intermediate-risk disease fared better with surgery.

Erectile dysfunction (ED) became more frequent for the men in the surgery group. At baseline, just over 30% of the men in both groups had ED. After surgery, ED rates for the surgery group increased to 80% and stayed at or above that level through the 10-year follow up. For men in the observation group, ED rates stayed around 40% for the first year after randomization, then gradually rose. Just over half of the observed men had ED at the five-year mark, and 70% experienced ED after 10 years.

Sexual activity also changed over time. At baseline, about half of the men said they had had intercourse (or other sexual activity) during the previous month. At the one-year mark, rates were 50.6% for the observation group and 26% for the surgery group. By the five-year mark, about a third of men in the observation group reported sexual activity, compared to 21.4% of the men who had surgery. At ten years, the rates were more similar: 20.1% for the observed men and 16.1% for the men who had surgery.

The men in the observation group also reported more sexual interest than the men in the surgery group over time.

“The benefits of surgery also need to be balanced against the negative long-term consequences of surgery that occur early and often,” said senior author Timothy Wilt, MD of the Minneapolis VA Health Care System and the University of Minnesota in a press release.

“Our results demonstrate that for the majority of men with localized prostate cancer, selecting observation for their treatment choice can help them live a similar length of life, avoid death from prostate cancer and prevent harms from surgical treatment. Physicians can use information from our study to confidently recommend observation as the preferred treatment option for men with early prostate cancer,” Dr. Wilt added.